“I Completely Shut Down”: A Mixed Methods Evaluation of the Fear–Avoidance Model for Young Adults With a Recent Concussion and Anxiety

Purpose/Objectives: The fear–avoidancemodel is awell-established framework for understanding the transition from acute to chronic pain. However, its applicability to concussions is not yet well understood. Here, we conduct the first mixed methods analysis of the fear–avoidancemodel in young adults with a recent concussion and co-occurring anxiety and assess the model’s alignment with their lived experience. Research Method/Design: We conducted a mixed methods analysis using a cross-sectional parallel design. Seventeen participants completed questionnaires corresponding with the elements in the fear–avoidance model (e.g., pain catastrophizing, avoidance, disability, anxiety, depression, etc.) and participated in semistructured interviews probing their experiences following their concussion between March 2021 and February 2022. We calculated bivariate correlations for quantitative data and analyzed the qualitative data using hybrid inductive–deductive thematic analysis. Results:Quantitative results demonstrated strong andmedium-sized correlations among theorized relationships within the fear–avoidance model (rs=.40–.85) with the majority being statistically significant. Qualitative results provided substantial convergent and complementary support (e.g., bi-directionality of some relationships, associations between nonadjacentmodel components, centrality of anxiety in symptom persistence) for the application of the fear–avoidancemodel to concussions. Findings highlighted additional factors (social factors and post-injury endurance patterns) relevant to this population. Conclusion/Implications: The fear–avoidance model is a useful lens for understanding the lived experience of young adults with a recent concussion and co-occurring anxiety. Psychosocial treatment for this populationwould benefit fromfocusing onthe interplay of concussion symptoms, anxiety, depression, disability, and pain-related fear, offering adaptive confrontation strategies, and addressing the interpersonal impact of concussion.